Cognitive Behavioral Therapies to Enhance Coping Skills

Behavioral interventions are important adjunct approaches to SCD treatment to address both pain and illness-related concerns. Many behavioral interventions have been developed based on the empirical finding that active coping strategies are associated with decreased pain and more positive psychosocial outcomes, whereas negative thinking and passive coping are associated with more pain and higher levels of psychological distress (Gil et al. 1989, 1991, 1993). Therefore, cognitive-behavioral therapy (CBT) interventions have been developed to target the thoughts and behaviors associated with an active, positive approach to coping. Many programs focus on teaching specific coping strategies, including relaxation techniques, imagery, problem-solving skills, and positive self-talk (Gil et al. 1997b; Powers et al. 2002; Thomas et al. 1998).

Based on results from randomized, controlled studies, Gil and colleagues reported that a one-session group coping skills intervention was associated with decreased negative thinking, lower levels of pain during laboratory-based pain stimulation (Gil et al. 1997b), and lasting reduction of pain and health care utilization in a subset of the children who actively practiced coping skills following the intervention (Gil et al. 2001); CBT was not associated, however, with decreased SCD-related pain in the children who did not report ongoing skills practice (Gil et al. 1996). Thomas et al. (1998) also showed some benefits of CBT, documenting that children who received the treatment showed increased positive coping and self-efficacy regarding their ability to manage their pain; however, the authors reported only weak evidence related to benefits of CBT for other psychological outcomes, such as symptoms of depression and anxiety